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Canada’s doctors are preparing to launch a full-court press to urge pregnant women in Canada to get the H1N1 flu vaccine, Canwest News Service has learned.

Special posters, fact sheets and mail outs will be sent to all maternity health-care providers across Canada, including hospitals, clinics and doctors’ offices, promoting immunization of pregnant women and advance prescriptions for the antiviral drug Tamiflu that could be filled at the first sign of symptoms.

“The message is very clear: first and foremost, immunization,” said Dr. Vyta Senikas, a vice-president of the Society of Obstetricians and Gynaecologists of Canada.

A special task force involving 15 partnering organizations met in Toronto this week to discuss a national effort to advise pregnant women about the risks of H1N1.

Dr. Senikas said the posters will feature the logos of the country’s major maternity-care organizations to show the public they are working together to address the high-risk nature of pregnant women catching the flu.

Meanwhile, the president of the society has written to doctors across the country, recommending they immunize women coming for regular prenatal visits wherever possible.

Dr. Michel Fortier said pregnant women in the third trimester or at term are one of the groups most at risk to be affected by H1N1.

“A number of women across Canada have died as a result of H1N1 thus far,” Dr. Fortier said in his letter to members of the Ottawa-based group. Pregnant women are not more likely to get the flu, but “the effects of H1N1 are more devastating in this group.”

Pregnant women who catch the virus are more likely to face complications such as pneumonia and severe respiratory distress. Severe complications can lead to early delivery or miscarriage, according to the Public Health Agency of Canada.

But Dr. Fortier said there is “great concern” about the historically low level of flu shots among the demographic. It’s estimated that fewer than 20 per cent of pregnant women get a seasonal flu shot.

“Pregnant women are reluctant to use any medication or take any immunizations,” Dr. Senikas said. “They’re always worried about side effects” the unborn children might encounter.

But, Dr. Senikas added, “We know it’s a flu that particularly affects the younger age group, and it’s that younger age group which is also pregnant.”

She pointed to the case of a young Montreal mother who died of swine flu in August. Her baby was delivered by an emergency cesarean section.

H1N1 particularly affects the lungs, “and if there are oxygenation issues for the mother, the fetus sometimes has to compensate for that,” Dr. Senikas said.

The virus doesn’t cross the placenta, so the fetus doesn’t get H1N1. But the complications caused by H1N1 in the mother can be detrimental to the infant’s health, Dr. Senikas said.

“Supposing [the mother] gets so sick that her lungs are not able to function anymore, so she has to go on a respirator. When there are oxygenation issues, that can affect the fetus also.”

Canada’s public health officials last week recommended pregnant women be among the first to be vaccinated when the H1N1 vaccine becomes available in November. But the rapid development of the H1N1 vaccine and the push to get it out ahead of a second wave of infection have raised concerns about safety.

“If there are things I can do to avoid exposure, absolutely I’ll do it, and at the first sign of any symptoms, I’m at my doctor’s office,”said Erika Shaker, who is at the end of her second trimester of pregnancy.

“But when it comes to actually being vaccinated using a substance that I don’t think has received adequate testing, I’m concerned. And I suspect a lot of women in my position are as well.”

As of Sept. 12, a total of 1,459 hospitalized cases — 288 of whom were admitted to an intensive care unit — and 76 deaths had been reported in Canada since the beginning of the H1N1 pandemic.

Dr. Senikas said pregnant women will be encouraged to talk to their doctor about getting a prescription for Tamiflu in advance. Early treatment, within 48 hours of the onset of symptoms, can reduce the risk of complications.

“If early symptoms develop, she cashes in the prescription, and she lets the health-care provider know for followup,” Dr. Senikas said. “She doesn’t have to go to the doctor’s office and infect every other pregnant woman there. She doesn’t have to go to the emergency department and sit for six hours with mild symptoms to get an antiviral prescription.”

But if severe symptoms develop, “we want her going to an emergency department.”

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Pregnant women focus of H1N1 flu campaign

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